| NPI | 1285014159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NJ 25MA10959600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125067206) |
| 208100000X Physical Medicine & Rehabilitation (Licence: GA 82623) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 306126) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2023-08-21 |